The Road to Strengthening Public Healthcare and Normalizing Medical Services Described by Former Congressman Shin Hyun-young

In a country where healthcare has come to a halt

The COVID-19 pandemic was a crisis that revealed the limitations of the healthcare system in South Korea. Despite the dedication of medical personnel, the concentration of medical infrastructure in metropolitan areas, the shortage of staff in essential medical fields, and the collapse of regional emergency and delivery systems starkly demonstrated inequalities in the health rights of the people. Additionally, the unilateral decision by the Yoon Suk-yeol administration to increase the number of medical school admissions by 2,000 led to a medical crisis marked by mass exoduses of residents and medical students, resulting in patients and the public suffering the most. In this context, the Lee Jae-myung administration has prioritized "strengthening public healthcare" as a core national policy since its early days. In the process of designing its direction and execution strategy, the voice of Shin Hyun-young, a former legislator and physician, has gained attention. He provides policy insights that consider both public interests and reality, drawing from his experience in both the medical field and government.

Strengthening Public Health Care: What Were the Issues and Where Should We Start?

The starting point for strengthening public health care is 'the region.' Medical personnel are concentrated in the metropolitan area, leading to the collapse of essential medical services in rural and remote areas. In particular, the number of medical staff in life-critical departments such as surgery, obstetrics and gynecology, and emergency medicine is decreasing, resulting in regional patients often being unable to receive appropriate care even in urgent situations. Former lawmaker Shin Hyun-young emphasized that 'we must not simply send doctors, but comprehensively design the living conditions as well as medical infrastructure.' The 'Local Doctor System' being promoted by the Lee Jae-myung government is not just a simple doctor dispatch system. It selects licensed doctors limited to eight essential medical specialties to work in specific areas for a certain period, with the government providing support for living conditions, labor costs, and educational opportunities in return. Pilot regions such as Gangwon, Jeonnam, Gyeongnam, and Jeju are being designated to design tailored policies that meet regional demands. This is not merely a way of forcing personnel into regions, but aims for a sustainable model that can grow together with the community.

Public Medical School vs Public Health Officer Academy

The establishment of a 'public medical school' has been discussed as a measure for training public healthcare personnel, but it has faced strong opposition from the medical community, making it difficult to advance. An alternative proposed is the 'public healthcare officer academy.' Similar to military academies, this system would have the state fully fund tuition and require graduates to serve in the public sector for a certain period. Former lawmaker Shin Hyun-young pointed out that the current 40 medical schools lack educational focus on public service, stating that we need to cultivate talents with a sense of public spirit and dedication, rather than merely training medical technicians. Especially in new areas of healthcare such as home care, integrated services, infectious disease response, and epidemiological investigations, it is emphasized that the existing medical school system cannot adequately train personnel, highlighting the necessity of a public healthcare officer academy.

Discussion on the Central Specialized Public Medical University Model

The central special purpose public medical school model proposed by Professor Ok Min-soo from Ulsan University of Science and Technology is also gaining attention. It is a proposal to establish a central public medical school and place regional campuses below it in a branch structure, standardizing the educational content and curriculum to train talents evenly across the country. This approach learns from the past failure of establishing a regional standalone public medical school like Namwon Seonam University, seeking a balance between central-local cooperation and balanced development. Former lawmaker Shin also emphasizes that "both efficiency and publicness must be captured through the connection between the central and local." If the government can secure design capacity and educational quality through this, it will be possible to train talent in a direction that is distinctly different from existing medical schools.

Resolving Legislative Conflicts: Practical Strategies and Philosophy

After the announcement of the expansion plan for medical school quotas by the Yoon Suk-yeol government, a collective exodus of residents and medical students has occurred. However, with the recent replacement of the leadership of the Residents' Council with more moderate members, a pragmatic negotiation stance is being formed. Former lawmaker Shin emphasized that 'all parties involved—government, doctors, and the public—are victims of this situation' and that it should no longer be a subject of political strife. The conditions proposed by young doctors to return to the field include realistic demands such as providing opportunities for retaking the national examination, guaranteeing chances for specialty exams, and increasing the proportion of doctors in educational governance. While the government cannot unilaterally accept these demands, it is keeping the door open for dialogue. Former lawmaker Shin stated that restoring trust between the medical community and the government through this process is of utmost importance.

The debate on medical school enrollment: the answer is 'scientific estimation'

The debate over how many medical school admissions should be increased must be based on scientific and neutral data analysis rather than political approaches. President Lee Jae-myung has also emphasized a phased approach of "expert-centered review → public discourse" since his presidential campaign. Former lawmaker Shin Hyun-young states, "We should respect the opinions of experts, but the final decision must be made from the perspective of the public." To achieve this, it is necessary to design an independent organization centered around researchers and conduct objective demand forecasts while excluding the influence of interest groups such as the Korean Medical Association.

Medical Profession: Freedom vs. Public Duty

There is controversy over whether mandating a certain period of compulsory regional service for graduates of public medical schools infringes upon the constitutional freedom of occupational choice. However, former lawmaker Shin cited interpretations from legal scholars stating that if it is a rational system design for the realization of public interest, it may not be unconstitutional. He explains that if the system is refined in a way that ensures voluntariness and choice, social consensus can be sufficiently achieved. In fact, regulations such as license restrictions in case of failure to comply with compulsory service are being reviewed under a "no-free-riding" clause, and there are also attempts to reduce trial and error during the initial phase of the system by implementing various options and flexibility.

Short-term response and long-term reform parallel strategy

In the short term, it is urgent to improve the payment system for healthcare professionals involved in essential medical care and to establish a safety net. The reality that many doctors face criminal liability and tens of billions of won in compensation when involved in medical accidents while treating critically ill patients is a major factor driving them to choose less risky fields. In response, former lawmaker Shin proposes the necessity of introducing a 'National Responsibility Guarantee System for Medical Accidents,' stating, 'Just as automobile insurance comes into play in traffic accidents, the state should share the responsibility in healthcare.' This could serve as an important mechanism not only for short-term workforce recovery but also for long-term restoration of public trust in healthcare.

National Responsibility for Caregiving Issues

Korea, having entered a super-aged society, is facing social issues such as "care bankruptcy" and "care homicide." Private caregiving costs reaching 3 to 5 million won a month are pushing many families to the brink of collapse. The support ratio provided by health insurance for integrated caregiving services is only about 10%, and practical solutions will require an expansion into home care and nursing facilities. Former lawmaker Shin emphasized that in order to address this issue, the proportion of national funding support in health insurance should be expanded and policies such as an integrated primary care physician system and regulation of excessive medical care during end-of-life stages should be implemented. President Lee Jae-myung also mentioned during his candidacy that "strengthening personal out-of-pocket expenses for unnecessary medical oversupply could be considered," raising expectations for a phased approach and institutional reform.

Where does true healing begin?

Public healthcare is not merely an issue of medical services. It is the will of the nation and the justice of society. As former lawmaker Shin Hyun-young said, 'If a doctor who heals patients can become a politician who heals society, that is the completion of another calling.' The first step to healing the wounds of healthcare collapse must begin in the community, in essential medical services, and at the frontline of protecting the lives of the people. The Lee Jae-myung government stands at a critical crossroads. Whether the philosophy of public healthcare will remain as a slogan or be translated into action depends on how this government views the health rights of the people, the medical community, and future generations. It is time for substantive changes so that the public will no longer suffer from healthcare gaps. This path will not be quick or easy, but it is an essential journey. And that path has already begun in the community.